Surgical device for wicking and removing fluid

ABSTRACT

A flexible, sterile, trimable device which gently and continuously removes unwanted fluid from an operating field during surgery by wicking the fluid into a mat having a high wicking property. A flexible suction tube having one end embedded in the mat removes fluid from the mat, thereby preventing the mat from becoming saturated. One embodiment of the invention is as a surgical swabber where one end of a length of semi-rigid tube is embedded in the mat and the other end is connected to a flexible suction tube. Another embodiment of the invention is as a platform for microsurgery where a membrane having a plurality of holes is applied to one side of the mat. The membrane supports the tissue being worked on and is preferably a contrasting color. Fluid passing into the holes is wicked into the mat where it is subsequently removed by the suction tube. The platform can be oriented in any position and does not slip on the tissue on which it is placed. Another embodiment of the invention is as a device that seals off the nose from the throat during nasal surgery so that blood from the nasal procedure will not go down the back of the throat. A nonporous sheet of silicone rubber or similar material is applied to one side of the mat. The sheet is sufficiently thick to give the device a springy quality which allows the device to be folded in half longitudinally then deploy into an inverted V configuration in the nasal cavity.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention pertains generally to medical devices. Moreparticularly, the invention relates to devices for removing fluid from apredetermined area during surgery. The apparatus and methods provided bythe invention are especially useful for microsurgery and nasal surgery.

2. Background Information

During surgery, unwanted fluids must be evacuated from the operatingfield. For large field surgery hi the chest, abdomen or pelvis forexample, this is often done by using a suction tube placed directly inpooled fluid such as blood. In microsurgery, however, because tissuesaffected are very small and delicate, use of direct suction even with avery small cannula and very low power can cause significant damage to,and even total destruction of, tissue exposed to the direct suction.

In large field surgery, fluid is also removed with sponges mounted onhandles such as disclosed in U.S. Pat. No. 1,853,238 to Shields and U.S.Pat. No. 2,294,186 to Kirschbaum. Similar sponge sticks with hollowhandles can be attached to a suction source as disclosed in U.S. Pat.No. 3,324,855 and U.S. Pat. No. 3,394,702 to Heimlich. All those devicesare relatively large and designed to be grasped with a hand. They arenot suitable for microsurgery where smaller workspace requires smallertools, and quantities of fluid removed are smaller. Furthermore, toabsorb liquids, those devices use gauze or elastomeric sythetic foamsponge for example. Because of their coarseness, these materials candamage delicate tissue typically involved in microsurgery when thematerials contact these tissues. Therefore, these devices are not wellsuited for microsurgery.

To remove fluid during microsurgery, a small swab on a stick is oftenused. Swabs on a stick were disclosed in U.S. Pat. No. 3,179,108 toBlock et at. Swabs used for microsurgery typically have an elongatedtriangular shape and are made of cellulose, for example. These arecommonly called eye spears because the triangular shaped swab mounted ona 2" long shaft resembles a spear. A device sold under the trade nameWECK-CEL is typical of those devices. Such a swab is small enough to behandled by the surgeon's fingers and fit in most areas of the body wheremicrosurgery is performed. However, multiple swabs are needed to removefluid in a typical microsurgery procedure since each swab quicklysaturates and must be replaced. Besides using several swabs, therepeated removing of the saturated swab and replacing it with a dry onetakes significant time and diverts the attention of the surgeon from thesubject procedure, which is neither safe nor efficient.

Microsurgery presents another problem not typical in large fieldsurgeries. Micro surgery is typically done on very small blood vessels,nerves, or other tissue which are delicate and often require abackground mat or platform on which to rest these tissues duringsurgery. Prior art platforms or backgrounds often become basins thatcatch unwanted fluids, such as blood, which makes such surgery moredifficult than if the platforms were clear of unwanted fluids. It isalso not desirable to have to intermittently swab the platform during anoperation to keep it clear of unwanted fluid.

U.S. Pat. No. 4,533,352 to Van Beek et at. discloses a flexible siliconerubber platform which incorporates suction in it. One embodiment of VanBeek's platform has a plurality of ribs and troughs with a hole in eachtrough connecting to a suction tube. The ribs support the tissue beingworked on and the troughs allow fluid to flow in them to the hole whereit is sucked away. In another embodiment, the tissues being worked on issupported by a porous pliable material. The porous pliable material hasa synthetic coating on its bottom and sides.

Drawbacks of both of Van Beek's platforms include that they rely ongravity to conduct fluid to the suction holes. Therefore, they must bepositioned so that fluid can move by gravity (rubber) or by directsuction (porous) to the holes. This significantly limits the positionsin which the platforms can be used. Also, Van Beek's platforms have arubber or plastic surface on the bottom which may be prone to becomingslippery when in contact with fluid, and which may allow the platform toslide on the tissue on which it is placed.

A further drawback of the Van Beek embodiment having a porous memberwith a synthetic coating on its edges is that the platform is not suitedfor trimming to fit a desired size or shape. Any trimming would remove asection of the coating on the edge which would allow the platform to"leak". While it is possible to recoat the edges after trimming, it isnot practical to do so. An alternative but expensive solution is to makethe platform in a great many predetermined geometrical shapes and sizes.

Another prior art platform is the TEBBETTS™ SOFT SUCTION MATT™manufactured by Applied Medical Technology, Inc. That platform has anonperforated membrane applied to a polyurethane foam pad which isapproximately 1.5 mm thick. A suction tube having a plurality of holesis attached between the membrane and the foam pad. The Tebbetts deviceis used with the membrane side down while the tissue being worked onrests on the foam.

A drawback of the Tebbetts device is that it can be used in only limitedorientations. Because the polyurethane foam has very poor wickingability, the device only works by pooling fluids in the foam above themembrane. The polyurthane foam is open-cell and acts as a conduit forfluid to flow to the suction tube. The device can be shaped to allowsuch pooling, but it does not work well in orientations which do notallow gravity to drain fluid toward the suction tube.

Another drawback of the Tebbetts device is that it slips. There is nomechanism to remove fluid which accumulates between the membrane and thetissue against which it is placed, so the device can slip on theaccumulated fluid.

A further drawback of the Tebbetts device is that it has no color. Whenblood pools in the foam pad, the pad turns red which makes it difficultto distinguish the tissue being worked on from the pad.

During nasal surgery, it is desirable to keep blood from the operationenvironment from draining down the patient's throat. This isconventionally done by a combination of nasal packing using gauze orother absorbent material and a hand held suction tube. The packing canbecome saturated with fluid and allow drippage or require changing. Thehand held suction device requires an operator which slows the procedureand may require additional surgical personnel.

It is an object of the invention to provide a swab device for use insurgery, particularly microsurgery, to remove excess fluid bycontinuously and gently wicking fluid away from tissue and into a padwhere it is subsequently removed by suction.

It is another object of the invention to provide a swab device for usein surgery to remove excess fluid which can be readily trimmed to anydesired size and shape.

It is another object of the invention to provide a swab device for usein surgery to remove excess fluid which can be used throughout anoperation without requiring replacement due to saturation or clogging.

It is another object of the invention to provide a swab device for usein surgery to remove excess fluid which will not damage delicate tissueit contacts.

It is another object of the invention to provide a flexible sterileplatform for use in surgery, which removes excess fluid from its worksurface by continuously and gently wicking fluid away into an integralpad where a suction tube subsequently removes it.

It is another object of the invention to provide a platform for use insurgery which removes fluid contacting its back side by gently wickingfluid into an integral pad where a suction tube subsequently removes it.

It is another object of the invention to provide a platform for use insurgery which can by oriented in any position.

It is another object of the invention to provide a platform for use insurgery which maintains a stable position and is slip-resistant on thetissue on which it is placed.

It is another object of the invention to provide a platform for use insurgery which is readily trimable to any desired size and shape.

It is another object of the invention to provide a device for nasalsurgery which seals off the nose from the throat.

It is another object of the invention to provide a device for nasalsurgery which prevents drainage of blood from the operational field downthe back of the patient's throat.

It is another object of the invention to provide a device for nasalsurgery which remove excess fluid by continuously and gently wickingfluid away from tissue and into a pad where a suction tube removes it.

SUMMARY OF THE INVENTION

The apparatus of the present invention provides a flexible, sterile,trimable device which gently and continuously removes unwanted fluidfrom an operating field during microsurgery or nasal surgery. Theinvention basically comprises a mat with a high wicking property, and aflexible tube with one end embedded in the mat. A preferred mat materialis rayon felt. The embedded end of the tube has at least one holethrough which suction is applied to the mat when the other end of thetube is attached to a suction source. The high wicking property of themat allows fluid to be gently and efficiently removed from a sitewithout the suction source being in direct contact with the poolingfluid. Suction removes fluid from the mat thereby preventing it frombecoming saturated.

One embodiment of the present invention is as a platform formicrosurgery. A membrane having a plurality of holes is applied to oneside of the mat. The membrane provides the work surface to support thetissue on which microsurgery is performed, and it preferably is of acolor contrasting with body tissue. Excess fluid on the membrane drainsthrough holes where it is wicked into the mat and subsequently removedby the suction tube. Since the platform uses wicking action rather thangravity to remove fluid from its work surface, the platform can be usedin any orientation. The platform allows evacuation of fluid from bothsides of platform. The wicking action of the mat keeps the back side ofthe platform from becoming slippery so that the platform does not slipfrom the position where it is placed.

Another embodiment of the present invention is as a swabber. One end ofa semi-rigid tube is embedded in the mat and the other end is connectedto a flexible tube which is in turn connected to a suction source.

Another embodiment of the invention is as a device used in nasalsurgery. A sheet of silicone rubber or similiar material is applied toone side of the mat. The sheet is non-porous and flexible, butsufficiently thick to give the device a springy quality. The device isfolded longitudinally with the sheet on the inside and the embedded tubeat the apex of the fold and inserted into a nasal cavity where it opensinto an inverted V shape which lodges against tissue and seals the nosefrom the throat. The device prevents fluid from the nasal operation fromdraining down the back of the throat by continuously wicking fluidfalling on the device into the mat where it is subsequently removed bythe embedded suction tube.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a an embodiment of the present inventionas a platform for microsurgery.

FIG. 2 is an illustration of a device of FIG. 1 as used in microsurgery.

FIG. 3 is a partially exploded view of a device of FIG. 1.

FIG. 4 is a longitudinal sectional view taken along line 4--4 of FIG. 1.

FIG. 5 is a cross sectional view taken along line 5--5 of FIG. 1.

FIG. 6 is a perspective view of a an embodiment of the present inventionas a swabbing device used for microsurgery.

FIG. 7 is a perspective view of the swab end of a device of FIG. 6.

FIG. 8 is a longitudinal sectional view taken along line 6--6 of FIG. 6.

FIG. 9 is a perspective view of a an embodiment of the present inventionas a device used for nasal surgery.

FIG. 10 is a longitudinal sectional view taken along line 10--10 of FIG.9.

FIG. 11 is an illustration of how a device of FIG. 9 is installed in anasal cavity.

FIG. 12 is a cross sectional view of a device of FIG. 9 in its installedposition of FIG. 11.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to the drawings, wherein like reference numerals designatelike or similar elements throughout, one embodiment of the invention asa platform for microsurgery is illustrated in FIGS. 1 through 5, asecond embodiment as a swabber is illustrated in FIGS. 6 through 8, anda third embodiment as a device for nasal cavity surgery is illustratedin FIGS. 9 through 12.

Microsurgery Platform

Referring to FIG. 1 a microsurgery platform 20 is used to isolate thestructure on which microsurgery is to be performed, such as a bloodvessel or nerve from surrounding tissue and provide a clean firm surfaceon which to work. The present invention provides a flexible, sterilemicrosurgery platform comprised of a wicking mat 22, a perforatedmembrane 24 attached to one side of mat 22, and a flexible tube 26having a terminal end 30 embedded in mat 22. Typical sizes of platform20 range from a 1" by 2" rectangle to a 4" by 6" rectangle, but platform20 can be readily trimmed to any size and shape needed. Mat 22 is madeof a material, preferably such as rayon felt, which has a high wickingproperty. The preferred embodiments of the invention use a rayon felt,such as orange SUNTEX™ from Solar United National Products, Inc., whichis approximately 2 mm thick. Blood clotting can be inhibited in the matby heparinizing it before use. Membrane 24 is thin, flexible and has aplurality of holes 28 perforating it which allow fluid passage throughmembrane 22 into mat 24. The holes can be made with a regular patternand spacing which allows the surgeon, by knowing the distance betweenthe holes, to gage the size of the vessels or other tissue being workedon. Membrane 22 may also be colored, preferably green, to contrast withtissue being worked on. In the preferred embodiment, membrane 22 is madeof colored plastic tape adhesively bonded to mat 22.

Tube 26 has a terminal end 30 which is embedded in mat 22 and has one ormore holes 32 at or near terminal end 30. Tube 26 has another end 34which may have a fitting 36 adapted to connect to a suction device (notshown).

In use, fluid either drains through holes 28 in membrane 24 to contactmat 22, or it contacts mat 22 directly at its exposed surfaces. Mat 22wicks fluid into it from its surface. fluid is removed from mat 22 bysuction in tube 26 causing fluid to flow from mat 22 through holes 32into tube 26 where it is carried away. Since fluid in a section of mat22 in the immediate vicinity of holes 32 has been evacuated, wickingaction of mat 22 causes fluid to flow from surrounding areas of mat 22toward a section where tube 26 is embedded in mat 22.

The advantages of microsurgery platform 20 are that the wicking actionof mat 22 conducts fluid to holes in tube 26 so that tube 26 need not bein direct contact with pooling fluid to evacuate it. This provides muchgreater flexibility in positioning platform 20 compared to otherplatforms which must be positioned so that fluid will run by gravity toevacuation holes. The construction of platform 20 allows evacuation offluid from both sides of platform 20, whereas conventional platformsmust pool fluid on the top side to evacuate it. Furthermore, platform 20does not slip from the position where it is placed as do other platformsmade of nonporous materials. Also, mat 22 acts as a buffer for thesuction force emanating from tubing 26. Direct suction, even though verylow power, can severely damage very delicate nerves and vesselstypically exposed during microsurgery if those tissues come in contactwith direct suction.

Referring to FIG. 2, microsurgery platform 20 is shown as used toperform microsurgery on vessel 40. Platform 20 can be trimmed to anysize or shape needed. The side of platform 20 with mat 22 exposed isplaced against tissue 40. Wicking action keeps the interface between mat22 and tissue 40 dry enough that platform 20 tends to stay in place evenwhen used in a vertical orientation as shown in FIG. 2. The orientationof platform 20 and tube 26 can be in any direction since it does notdepend on gravity to function. Also as shown in FIG. 2, platform 20 isflexible enough to easily curve to the natural shape of many tissues.Platform 20 is inserted between the structure on which microsurgery isto be performed, vessel 42 in this illustration and the underlyingtissue 40. The contrasting color, preferably green, of membrane 24 andvessel 42 give the surgeon a good visual field on which to operate.Membrane 24 also remains clear of excessive fluid during surgery. Fluidfrom vessel 42 or the surrounding tissue does not accumulate on membrane24 since fluid on membrane 24 goes through holes 28 and into mat 22where it is wicked away and subsequently evacuated by tube 26.

Referring to FIG. 3, tube 26 is embedded in mat 22 such that terminalend 30 of tube 26 does not extend to edge 44 of mat 22 and all holes 32are inside mat 22. An adhesive (not shown), such as silicone, is appliedat point 52 where tube 26 exits mat 22 to keep tube 26 in place.

Referring to FIGS. 4 and 5, when tube 26 is inserted into mat 22, itforces a portion 50 of mat 22 to bulge out. The thickness 46 of bulgingportion 50 of mat 22 is approximately equal to thickness 48 of mat 22opposite bulging portion 50. It is preferable but not necessary thatholes 32 be oriented as shown in the plane of mat 22. In the preferredembodiment membrane 24 is attached to mat 22 by an adhesive layer 38,but it is possible that membrane 24 could be attached to mat 22 by othermeans such as thermal bonding.

Surgical Swabber

Referring to FIG. 6, another embodiment of the invention is shown asused as a swabber 120. A swabber is used to intermittently evacuatefluid from an operating field. Swabber 120 is comprised of a wicking mat122, a semi-rigid tubular wand 124 having one end 130 terminate insidemat 122 and another end 128 attached to flexible tube 126. Tube 126 mayhave a flexible coupling 138 for attaching to end 128 of wand 124. Theother end 134 of tube 126 has a fitting 136 adapted to connect to asuction device (not shown). Mat 22 is made of a material, preferablysuch as rayon felt, which has a high wicking property. Swabber 120 ismuch smaller than a conventional stick sponge and is designed to begripped with the fingers, not the whole hand. Wand 124 can have variousdiameters and lengths with typical outer diameter ranging fromapproximately 1 to 2 mm and lengths ranging from 8 to 12 cm. In thepreferred embodiment, mat 122 is approximately 2 mm thick and 5 to 10 mmwide by 10 to 20 mm long. It can be trimmed to any suitable size andshape.

Referring to FIGS. 7 and 8, end 130 of wand 124 is insertedapproximately in the center of the thickness of mat 122 causing bulges140 and 140 of approximately equal thickness in mat 122. Adhesive 144,preferably silicone, bonds wand 124 to edge 146 of mat 122. End 130 ofwand 124 has one orifice 132 at end 130 through which suction is appliedto mat 122.

As with the microsurgery platform described above, mat 122 wicks fluidinto it from its surface. Fluid is removed from mat 122 by suction inwand 124 causing fluid to flow from mat 122 through hole 132 into wand124 where it is carded away. Since fluid in a section of mat 122 in theimmediate vicinity of hole 132 has been evacuated, wicking action of mat122 causes fluid to flow from surrounding areas of mat 122 toward asection where wand 124 is embedded in mat 122. Therefore, fluid can beevacuated without wand 126 being in direct contact with pooling fluid toevacuate it. Also, mat 122 acts as a buffer for the suction forceemanating from wand 124. Direct suction, even though very low power, canseriously damage very delicate nerves and vessels typically exposedduring microsurgery if those tissues come in contact with directsuction. Furtherefore, small cannulas typically used for suction oftenplug with tissue and stop functioning. Mat 122 acts as a filter toprevent such tissue from entering wand 124 thereby preventing blockageof wand 124 or tube 126. One swabber 120 can eliminate the need fordozens of cotton tipped applicators or similar devices typically used toswab fields during microsurgery. It also reduces the time needed to swaba field since swabber 120 is held in place until the field issufficiently clear of fluid, compared to repeatedly applying, removing,and changing cotton tipped applicators.

Nasal Surgery Device

Another embodiment of the invention is designed for use in nasalsurgery. It is essentially the same as microsurgery platform 120described above, except that perforated membrane 24 is replaced with anonporous silicone rubber sheet.

Referring to FIGS. 9 and 10, device 220 is comprised of wicking mat 222,a sheet 224 attached to one side of mat 222 and a flexible tube 226having a terminal end 230 embedded in mat 222. Mat 222 is made of amaterial, preferably such as rayon felt, which has a high wickingproperty. Sheet 224 is non porous and flexible, but sufficiently thickto give device 220 a springy quality. Sheet 224 is preferably made ofsilicone rubber and in the preferred embodiment is between 0.5 and 1 mmthick. Device 220 typically has a rectangular shape approximately 25 mmby 50 mm but it can be readily trimmed to any size and shape needed.Sheet 224 is attached to mat 222 by adhesive 238, preferably silicone.Tube 226 has a terminal end 230 which is embedded in mat 222 and has oneor more holes 232 at or near terminal end 230. Tube 226 has another end234 which may have a fitting 236 adapted to connect to a suction device(not shown).

Tube 226 is embedded in mat 222 such that terminal end 230 of tube 226does not extend to edge 244 of mat 222 and all holes 232 are inside mat222. An adhesive (not shown), such as silicone, is applied at point 252where tube 226 exits mat 222 to keep tube 226 in place.

When tube 226 is inserted into mat 222 it forces a portion 250 of mat222 to bulge out. The thickness 246 of bulging portion 250 of mat 222 isapproximately equal to thickness 248 of mat 222 opposite bulging portion250. It is preferable but not necessary that holes 232 be oriented asshown in the plane of mat 222. For this embodiment it is possible thatthe tube be located between mat 222 and sheet 224 rather than embeddedin mat 222.

Mat 222 wicks fluid into it from its surface. Fluid is removed from mat222 by suction in tube 226 causing fluid to flow from mat 222 throughholes 232 into tube 226 where it is carded away. Since fluid in asection of mat 222 in the immediate vicinity of holes 232 has beenevacuated, wicking action of mat 222 causes fluid to flow fromsurrounding areas of mat 22 toward a section where tube 226 is embeddedin mat 222.

Referring to FIGS. 11 and 12, in use, device 220 is folded into aninverted V as shown with sheet 224 on the inside of the V and tube 226at the apex 240 of the V. It is lodged into position between the floor262 of the nose and the back of the nasal cavity. Device 220 functionsto seal off the nose from the throat so that blood from the nasalprocedure in cavity 260 will not go down the back of the throat. Device220 replaces conventional nasal packing and hand held suction cannula.

Device 220 is inserted along the floor 262 of the nose by folding it inhalf longitudinally with tube 226 being the fold line. When in positionits inherent springy quality opens device 220 to an inverted V shape asshown where edges 252 and 254 contact walls of the nasal cavity 260.

The descriptions above and the accompanying drawings should beinterpreted in the illustrative and not the limited sense. While theinvention has been disclosed in connection with the preferred embodimentor embodiments thereof, it should be understood that there may be otherembodiments which fall within the scope of the invention as defined bythe following claims. Where a claim is expressed as a means or step forperforming a specified function it is intended that such claim beconstrued to cover the corresponding structure, material, or actsdescribed in the specification and equivalents thereof, including bothstructural equivalents and equivalent structures.

What is claimed is:
 1. A device for removing excess fluid duringsurgical procedures, comprising:(a) a flexible mat having a high wickingproperty: and (b) a flexible tube having a substantially straight endsection embedded in said mat, said tube having at least one hole in saidembedded end section, and (c) a flexible, nonporous sheet attached toone side of said mat, said sheet rendering the device elastic, wherebythe device is used according to the following methodology:(i) saiddevice is folded along said substantially straight embedded end sectionof said tube with said sheet on the inside; (ii) said folded device isinserted into a nasal cavity of a patient and positioned behind the baseof nose; and (iii) said device unfolds into an inverted V shape thatlodges in said nasal cavity and seals the nose from the throat, therebypreventing fluid from surgical procedure in the nose from draining downthe throat.
 2. The device of claim 1 wherein said embedded end sectionof said tube and a length extending from said mat is semi rigid.
 3. Thedevice of claim 2, wherein a flexible tube is attached to an endopposite said embedded end of said semi rigid tube.
 4. The device ofclaim 1 further comprising a membrane attached to one side of said matwherein said membrane has a plurality of holes passing through saidmembrane.
 5. The device of claim 4 wherein said membrane is colored tocontrast with body tissue.
 6. The device of claim 1 wherein said mat iscomprised of rayon felt.